Fast-track program for hip replacement

September 30th — admin

Have you ever heard of a fast-track program for total hip replacements? That’s what my father is on, and we are just wondering what it means.

Patients and surgeons are both interested in a speedy, painless recovery from surgery after a total hip replacement. To reach that goal, surgeons have introduced something called a minimally-invasive surgery (MIS). Minimally invasive surgery refers to any operation where the surgeon changes how long or how deep the cut is made into the tissue. With some minimally invasive approaches, the surgeon can avoid cutting into most of the muscles around the hip that are normally removed from the bone during the standard hip replacement surgery. The hope is that with less trauma to the soft tissues (especially the muscles around the hip), the patient will be able to recover that much faster.

There are also some efforts to speed up the rehab or postoperative recovery process. A program called the fast-track has been designed to accomplish this. Several studies have shown that patients who are on the fast-track after surgery get better faster. The fast-track means they get a patient-controlled pump to manage their pain. They start rehab sooner, and the therapist provides a more aggressive program. In studies so far, patients in the fast-track groups are discharged sooner, can walk better, and are more satisfied than patients following the standard rehab protocol. This is true no matter what type of incision or approach was used to do the surgery.

Not everyone can participate in a fast-track program. Patients are selected based on general health, motivation, and compliance level. Complications after surgery such as infection, dislocation, or fracture can put an end to someone’s fast-track status. But for those who are able to complete the program, the results have been very impressive.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Patient wants tiny incision

September 28th — admin

I’m going to have a total hip replacement next week with the new minimally invasive surgery. The surgeon has explained how this is to my advantage, but mostly, I’m just interested in having a tiny incision. Am I going to be sorry I didn’t have the standard type of incision? Will my vanity come around and bite me in the butt, so-to-speak?

You’re not alone in your concern about form over function. Even if the minimally-invasive approach doesn’t yield better functional outcomes, patients like how it looks. A shorter incision just looks better, and patients are asking for that. Patients also want an implant that will last as long as possible. And that factor is more important to them than the length of the scar or how long they are in the hospital.

There are many advantages to a minimally-invasive approach. And we’re not talking about just a shorter incision line. Minimally invasive refers to the fact that the group of muscles usually cut to remove the old hip joint aren’t touched. The gluteus maximus (buttock) muscle is split to get to the hip joint, but the length of the split is much shorter. The incision into the joint capsule is also smaller and repaired without any negative effects.

Studies are ongoing to assess the results of minimally-invasive surgeries. There are mixed reviews as to outcomes. In some studies, the operating time is shorter and there’s less blood loss. In others, the operation is complex and may take more time if the surgeon hasn’t done quite a few of them. But the long-term results (a year or more later) don’t really show much of an advantage of the minimally invasive approach over the standard incision. Walking distance, walking speed, and muscle strength appear to even out between the two surgical approaches. There are still plenty of factors to consider when comparing the two approaches. Patient education, preoperative counseling, analgesia, and rehabilitation programs may be the real keys to recovery. While the surgical approach might make a difference, there’s at least enough preliminary information to suggest that the postoperative treatment process may be equally (if not more) important.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What makes a surgery count as “minimally invasive?”

September 27th — admin

What makes a surgery count as “minimally-invasive”? It seems like surgery is a major trauma to the body no matter how short the time it takes.

Minimally invasive refers to several factors. A shorter operating time as you suggest is one measure. A shorter operation means less anesthesia. Sometimes there’s less blood loss. Those two things alone can also mean “less invasive” to the pocketbook.

According to a task force of surgeons there are several ways to tell if an operation is minimally invasive. First, the size of the incision is half the length of the standard approach.

Second the location of the cut is often different. The goal is to avoid disrupting the joint capsule or some of the muscles. If the capsule is cut, a smaller incision is used.

Third, fewer muscles are cut or detached.

During knee surgery anytime the surgeon can avoid cutting the extensor mechanism, it’s considered “less invasive.” The extensor mechanism is made up of the quadriceps muscle as it comes down over the front of the thigh and attaches around the patella or kneecap.

Disrupting this muscle can cause weakness in knee extension. The patient may not be able to fully extend the knee, a condition called extensor lag.

There isn’t one single way to define minimally invasive but rather, a group of factors.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Pain on inside of hip could be arthritis

September 22nd — admin

I have a deep pain in my groin that my doctor diagnosed as a hip problem – arthritis. I always thought if you had hip pain, it was on the outside?

Hip pain from problems like osteoarthritis does often show up in the inner thigh or groin area, more so than the outside. This is because of the anatomy of the joint and where the ball of the femur, the thigh bone, fits into the socket of hip joint. It’s in the inner part of the hip that the motion takes place that allows you to move your leg inward and outward again.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Soccer player chooses surgery for snapping hip syndrome

September 20th — admin

After a very long and unsuccessful attempt at treating my snapping hip syndrome, I finally decided to have surgery to release the hip tendons on both sides. I’m hoping to be through rehab by the time soccer season starts again. How long does it take to get my full strength and motion back?

Some athletes are bothered by a painful snapping at the hip when moving the leg from a flexed to an extended position. There can be a variety of reasons why this happens. Some occur outside the joint such as when a tendon rubs over a bony prominence. Others are caused by something going on inside the joint. It could be a tear in the labrum (rim of cartilage around the hip socket) or a loose fragment inside the joint. The most common cause is the iliopsoas tendon rubbing over a bony bump called the iliopectineal eminence. Many times there is also a fraying or a tear of the labrum contributing to the problem.

Whatever the cause, treatment is needed to help the athlete get back into action. At first, conservative care with rest, stretching exercises, and antiinflammatory drugs is advised. A nonoperative approach should be tried for at least six months. Sometimes a steroid injection with a numbing agent into the iliopsoas bursa helps. When none of these approaches reduces or relieves painful snapping symptoms, then surgery may be advised. The surgeon can partially or fully cut the iliopsoas tendon away from the bone. The tendon retracts and reattaches to the nearby soft tissue.

Recovery and rehab takes at least 10 to 12 weeks. At first, you won’t be able to bend the hip. This makes you unstable when trying to walk or use coordinated movements of the legs. This new symptom will last two to four weeks until the tendon reattaches and heals in its new location. You’ll be given some simple exercises to do at first. You will probably work with a physical therapist who will supervise how much weight you put on the leg(s), how to use crutches or canes, and a progression of leg control exercises. Eventually stretching exercises will be included, then coordination exercises, and finally, sport-specific movements. When you can control your motion, have 90 per cent strength, and can handle impact activities, then you will be released to return to the soccer field.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What is a cervical hip fracture?

September 14th — admin

Have you ever heard of a cervical hip fracture? What is that? I thought the cervical bones were in the neck, not in the hip.

There are many types of hip fractures, usually named for their location. A basic understanding of the hip anatomy will help visualize where the fractures occur.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum. It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck. A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter.

These two bumps on the femur are where some of the hip muscles attach. A cervical hip fracture refers to the fact that the break is inside the joint itself. Either the top of the femur (called a subcapital fracture) or the acetabulum (hip socket) have a break. Another term for the location of these fractures is intracapsular or cervical.

When the break affects the hip, but is not right inside the hip, the fracture is referred to as an extracapsular hip fracture. The fracture may occur in the neck of the femur (femoral neck fracture), between the two trochanters (intertrochanteric fracture), or in the main shaft of the femur just below the lesser trochanter and may extend down the shaft of the femur. This last type of hip fracture is called a subtrochanteric fracture.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Dislocate hip to fix it?

September 12th — admin

I saw a surgeon who wants to do surgery to dislocate my hip in order to fix it so it won’t keep pinching the joint cartilage when I bend and rotate my leg. I’m thinking, no thanks. Is there a better way to take care of this problem?

It sounds like you might have a condition called femoroacetabular impingement (FAI). With FAI, the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated.

Surgery is often recommended as the most successful treatment for this problem. There are three surgical choices: 1) surgical hip dislocation, 2) periacetabular osteotomy, and 3) hip arthroscopy. Surgical hip dislocation is considered the current gold standard, though some experts expect improved arthroscopic techniques will change that in the future. Surgical dislocation refers to taking the femoral head out of the socket and making adjustments and repairs as necessary, and then putting the head back in place. The operation can be done without cutting through the muscles and with the least amount of trauma possible.  Any damage to the labrum (rim of cartilage around the hip socket) can be repaired. Any problems with mismatch of the femoral head and neck with the acetabulum (hip socket) can be taken care of. This type of surgery allows for preservation of the joint, which is important in young, active adults.

Periacetabular osteotomy corrects the retroversion (tipped or tilted position of the acetabulum). The capsule surrounding the hip joint is cut open. The femoral head and neck are reshaped by shaving or cutting off portions of the bone. The goal is to correct the placement of the femoral head in the hip socket.

The third surgical option (hip arthroscopy) to treat FAI allows the surgeon to gain access to the inside of the joint without cutting it open. This avoids pulling the femoral head away from the socket. Arthroscopic surgery also makes it possible to reattach (rather than remove) a torn labrum.

Studies show that the best way to approach this problem is by restoring as normal hip anatomy as possible. Surgical hip dislocation is used with good success for patients with mild to moderate (but not severe) degeneration of the joint cartilage, surface, and surrounding capsule. It sounds like your surgeon is right on track with current evidence for best practice. You can always seek a second opinion to help you understand your condition and the various treatment options available.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Even loose-jointed yoga instructor has hip pain

September 8th — admin

I am a yoga instructor with a very painful hip. I can’t figure it out because my joints are very loose. But every time I flex my hip past 90-degrees or try to cross my legs, I get a very sharp pain deep in my hip. What could be causing this?

Hip pain with limitations on full hip motion in an active adult requires special attention — especially if you are in your 20s or 30s. Early diagnosis and treatment is imperative to avoid degenerative changes in the hip joint later in life. There are many possible causes of this type of hip pain.

Given your description, one of the most likely would be femoroacetabular impingement (FAI). Femoroacetabular impingement (FAI) describes a condition where the top of the femur (thigh bone) pinches the rim of the hip socket. The area that gets compressed is referred to as the acetabular rim. This type of impingement occurs most often when the hip is flexed and internally rotated. For a long time, it was believed that FAI only occurred in people with some kind of abnormal anatomy of the hip. There was either a backward tilted angle of the hip socket called retroversion, a larger socket than the ball (head of the femur) inside the socket, or flattening of the femoral head. One type of abnormal shape of the hip was labeled a pistol grip because of the resemblance to the grip of a handgun.

More recent studies have shown it’s possible to develop FAI even when the hip structure and anatomy are essentially normal. But, in general, more people with acetabular retroversion end up with hip pain and problems leading to degenerative hip osteoarthritis than any others.

To get to the bottom of the cause of hip pain, a thorough history and examination are required. An orthopedic surgeon is the best one to see. The physician will look at your foot position, leg angles, leg length differences from one side to the other, hip motion, and muscle strength. Gait (walking) patterns will be evaluated. Special tests such as the impingement test are done to identify the presence of an underlying FAI as the cause of the painful symptoms and restricted motion. X-rays, CT scans and/or MRIs may be used to confirm the diagnosis.

The results of all of these tests are important pieces of information when deciding on the best treatment approach. With early diagnosis and treatment of young, active patients with FAI the problem can be managed by conservative measures. Surgery may be needed to restore as normal hip anatomy as possible. But before jumping to any conclusions, make an appointment and see a specialist to find out for sure what might be causing the problem. If you’ve had this for a while and it hasn’t gone away (even with your yoga practice), don’t wait any longer.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Why Mom won’t get her hip replaced

September 6th — admin

We are trying to help Mother make up her mind about having a hip replacement. Dad had it done a year ago and everything went quite well. We can’t figure out her hesitation. What do you suggest?

It’s not uncommon for women to lag behind men when it comes to having elective surgery such as a total hip or total knee replacement. Women tend to worry more about taking care of their families after surgery. The unknown factors of how long it will take to get back up on their feet and independent can hold them back. In many cultures, men are more used to being taken care of and provided for in the home. Becoming more dependent in these areas after surgery is not such a stumbling block for them. Women may have a more difficult time asking for and accepting help from others.

The first step may be just to have her evaluated by your surgeon of choice. He or she may be able to answer any questions you or your mother may have. Asking questions about healing time, length of hospitalization, expected time for recovery may help your mother decide what’s best for her. Most patients are seen right away in the hospital by a physical therapist. The therapist helps them get up and get moving again. Joint motion and muscle strengthening are part of the rehab program. The therapist will advise patients about what’s needed at home. If your father had this surgery a year ago, it’s likely they already have everything they need (e.g., raised toilet seat, walker or cane, grab bars in the bathroom).

These are just a few suggestions for getting to the bottom of your mother’s hesitation. If you think she could (and would) tell you, perhaps asking her straight out might help solve the issue. It is a big step for many people but most patients agree that the benefits are well worth the effort.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Should dementia prevent hip replacement surgery?

August 10th — admin

Do you think dementia should prevent my father from having a total hip replacement? He is still in good health and otherwise mobile. But we are worried he’ll get up and walk on it when he shouldn’t.

Quality of life is an important issue at any age and in any circumstance. The presence of Alzheimer’s, dementia, or other neurologic problem must be considered but isn’t a reason to withhold treatment.

In the case of hip replacements, an assessment of need should be done. An orthopedic surgeon is the best one to consult for this. There may be other less invasive treatments that can make a difference. Physical therapy to help restore motion and strength can help. If they haven’t been tried yet, cortisone injections and/or antiinflammatory medications may provide some effective relief. And if it turns out that surgery really is the best option, the surgeon will modify treatment to take the cognitive condition of the patient into account. For example, there are minimally invasive surgical techniques that can be used to take the old joint out and put the new implant in. The postoperative protocol allows for early weight-bearing. There are fewer restrictions on movements and positions.

The type of implant used can be chosen based on the patient’s specific needs. A larger femoral head component helps reduce the risk of dislocation. Cementing the prosthesis in place also makes for a more stable joint. Preventing complications is a key factor in cases like this. Having a team approach with family, patient, and health care providers will go a long way to provide a good result.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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